Surgical treatment of Obstructive sleep apnea: adenotonsillectomy in adults
Abstract Introduction and objective: Obstructive sleep apnea (OSA) is a multifactorial etiology disease that leads to the collapse of the upper airway. Hypertrophy of lymphoid tissues contributes to airway collapsibility. Conceptual review of adenotonsillectomy in the adult patient with OSA. Synthesis: In the presence of grade ≥3 tonsillar hypertrophy, tonsillectomy is the first-line treatment. The different available adenotonsillectomy techniques are suitable for treating patients with OSA. The integrity of the palatoglossus and palatopharyngeus muscles must be respected. In addition to healing and surgical success, tonsillectomy offers benefits such as reducing necessary pressure applied to CPAP and consequently increasing its tolerance. Conclusions: The removal of hypertrophic lymphoid tissues in adult patients with OSA is essential. This surgery eliminates obstructive elements from the upper airway, favoring its patency and stability.
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Cahali MB, Soares CF de P, Dantas DA da S, Formigoni GGS. Tonsil volume, tonsil grade and obstructive sleep apnea: is there any meaningful correlation? Clinics (Sao Paulo). 2011;66(8):1347-52.
Nolan J, Brietzke SE. Systematic review of pediatric tonsil size and polysomnogram-measured obstructive sleep apnea severity. Otolaryngol Head Neck Surg. 2011;144(6):844-50.
Oliveira MCS, Tufik S, Haddad FLM, Santos-Silva R, Gregório LC, Bittencourt L. Systematic Evaluation of the Upper Airway in a Sample Population: Factors Associated with Obstructive Sleep Apnea Syndrome. Otolaryngol Head Neck Surg. 2015;153(4):663-70.
Luz Alonso-Álvarez M, Canet T, Cubell-Alarco M, Estivill E, Fernández-Julián E, Gozal D, et al. [Consensus document on sleep apnea-hypopnea syndrome in children (full version). Sociedad Española de Sueño. El Área de Sueño de la Sociedad Española de Neumología y Cirugía Torácica(SEPAR)]. Arch Bronconeumol. 2011;47 Suppl 5:0, 2-18.
Havas T, Lowinger D. Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy. Arch Otolaryngol Head Neck Surg. 2002;128(7):789-91.
Yang L, Shan Y, Wang S, Cai C, Zhang H. Endoscopic assisted adenoidectomy versus conventional curettage adenoidectomy: a meta-analysis of randomized controlled trials. Springerplus. 2016;5:426.
Agrawal V, Agarwal PK, Agrawal A. Defining the Surgical Limits of Adenoidectomy so as to Prevent Recurrence of Adenoids. Indian J Otolaryngol Head Neck Surg. 2016;68(2):131-4.
Havas T, Lowinger D. Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy. Arch Otolaryngol Head Neck Surg. 2002;128(7):789-91.
Costantini F, Salamanca F, Amaina T, Zibordi F. Videoendoscopic adenoidectomy with microdebrider. Acta Otorhinolaryngol Ital. 2008;28(1):26-9.
Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, et al. International Consensus Document on Obstructive Sleep Apnea. Arch Bronconeumol (Engl Ed). 2021;S0300-2896(21)00115-0.
Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope. 1999;109(12):1901-7.
Shotts SD, Welsh DV, Nakamura A, Stromberg AJ. Very-Low Energy Monopolar Reduces Post-Tonsillectomy Hemorrhage Versus Standard Energy Techniques. Laryngoscope. 2021;131(11):2505-11.
Sancaktar ME, Çelebi M, Yıldırım M, Can E, Akgül G, Ağrı İ, et al. Safety of outpatient admission and comparison of different surgical techniques in adult tonsillectomy. Eur Arch Otorhinolaryngol. 2019;276(4):1211-9.
Pynnonen M, Brinkmeier JV, Thorne MC, Chong LY, Burton MJ. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev. de 2017;8:CD004619.
Camacho M, Li D, Kawai M, Zaghi S, Teixeira J, Senchak AJ, et al. Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope. septiembre de 2016;126(9):2176-86.
Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996;19(2):156-77.
Li HY, Wang PC, Lee LA, Chen NH, Fang TJ. Prediction of uvulopalatopharyngoplasty outcome: anatomy-based staging system versus severity-based staging system. Sleep. diciembre de 2006;29(12):1537-41.
Choi JH, Cho SH, Kim SN, Suh JD, Cho JH. Predicting Outcomes after Uvulopalatopharyngoplasty for Adult Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg. 2016;155(6):904-13.
Tschopp S, Tschopp K. Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea. Laryngoscope. 2019;129(12):E449-54.
Matarredona-Quiles S, Carrasco-Llatas M, Martínez-Ruiz de Apodaca P, Ortega-Beltrá N, Dalmau Galofre J. Is there a relationship between tonsil volume and the success of pharyngeal surgery among adult patients with obstructive sleep apnea? Brazilian Journal of Otorhinolaryngology. 2022; 2022;88(1):1-7.
Almeida FR, Bansback N. Long-term effectiveness of oral appliance versus CPAP therapy and the emerging importance of understanding patient preferences. Sleep. 2013;36(9):1271-2.
Nakata S, Noda A, Yanagi E, Suzuki K, Yamamoto H, Nakashima T. Tonsil size and body mass index are important factors for efficacy of simple tonsillectomy in obstructive sleep apnoea syndrome. Clin Otolaryngol. 2006;31(1):41-5.
Ericsson E, Ledin T, Hultcrantz E. Long-term improvement of quality of life as a result of tonsillotomy (with radiofrequency technique) and tonsillectomy in youths. Laryngoscope. 2007;117(7):1272-9.
Nolan J, Brietzke SE. Systematic review of pediatric tonsil size and polysomnogram-measured obstructive sleep apnea severity. Otolaryngol Head Neck Surg. 2011;144(6):844-50.
Oliveira MCS, Tufik S, Haddad FLM, Santos-Silva R, Gregório LC, Bittencourt L. Systematic Evaluation of the Upper Airway in a Sample Population: Factors Associated with Obstructive Sleep Apnea Syndrome. Otolaryngol Head Neck Surg. 2015;153(4):663-70.
Luz Alonso-Álvarez M, Canet T, Cubell-Alarco M, Estivill E, Fernández-Julián E, Gozal D, et al. [Consensus document on sleep apnea-hypopnea syndrome in children (full version). Sociedad Española de Sueño. El Área de Sueño de la Sociedad Española de Neumología y Cirugía Torácica(SEPAR)]. Arch Bronconeumol. 2011;47 Suppl 5:0, 2-18.
Havas T, Lowinger D. Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy. Arch Otolaryngol Head Neck Surg. 2002;128(7):789-91.
Yang L, Shan Y, Wang S, Cai C, Zhang H. Endoscopic assisted adenoidectomy versus conventional curettage adenoidectomy: a meta-analysis of randomized controlled trials. Springerplus. 2016;5:426.
Agrawal V, Agarwal PK, Agrawal A. Defining the Surgical Limits of Adenoidectomy so as to Prevent Recurrence of Adenoids. Indian J Otolaryngol Head Neck Surg. 2016;68(2):131-4.
Havas T, Lowinger D. Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy. Arch Otolaryngol Head Neck Surg. 2002;128(7):789-91.
Costantini F, Salamanca F, Amaina T, Zibordi F. Videoendoscopic adenoidectomy with microdebrider. Acta Otorhinolaryngol Ital. 2008;28(1):26-9.
Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, et al. International Consensus Document on Obstructive Sleep Apnea. Arch Bronconeumol (Engl Ed). 2021;S0300-2896(21)00115-0.
Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope. 1999;109(12):1901-7.
Shotts SD, Welsh DV, Nakamura A, Stromberg AJ. Very-Low Energy Monopolar Reduces Post-Tonsillectomy Hemorrhage Versus Standard Energy Techniques. Laryngoscope. 2021;131(11):2505-11.
Sancaktar ME, Çelebi M, Yıldırım M, Can E, Akgül G, Ağrı İ, et al. Safety of outpatient admission and comparison of different surgical techniques in adult tonsillectomy. Eur Arch Otorhinolaryngol. 2019;276(4):1211-9.
Pynnonen M, Brinkmeier JV, Thorne MC, Chong LY, Burton MJ. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev. de 2017;8:CD004619.
Camacho M, Li D, Kawai M, Zaghi S, Teixeira J, Senchak AJ, et al. Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope. septiembre de 2016;126(9):2176-86.
Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996;19(2):156-77.
Li HY, Wang PC, Lee LA, Chen NH, Fang TJ. Prediction of uvulopalatopharyngoplasty outcome: anatomy-based staging system versus severity-based staging system. Sleep. diciembre de 2006;29(12):1537-41.
Choi JH, Cho SH, Kim SN, Suh JD, Cho JH. Predicting Outcomes after Uvulopalatopharyngoplasty for Adult Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg. 2016;155(6):904-13.
Tschopp S, Tschopp K. Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea. Laryngoscope. 2019;129(12):E449-54.
Matarredona-Quiles S, Carrasco-Llatas M, Martínez-Ruiz de Apodaca P, Ortega-Beltrá N, Dalmau Galofre J. Is there a relationship between tonsil volume and the success of pharyngeal surgery among adult patients with obstructive sleep apnea? Brazilian Journal of Otorhinolaryngology. 2022; 2022;88(1):1-7.
Almeida FR, Bansback N. Long-term effectiveness of oral appliance versus CPAP therapy and the emerging importance of understanding patient preferences. Sleep. 2013;36(9):1271-2.
Nakata S, Noda A, Yanagi E, Suzuki K, Yamamoto H, Nakashima T. Tonsil size and body mass index are important factors for efficacy of simple tonsillectomy in obstructive sleep apnoea syndrome. Clin Otolaryngol. 2006;31(1):41-5.
Ericsson E, Ledin T, Hultcrantz E. Long-term improvement of quality of life as a result of tonsillotomy (with radiofrequency technique) and tonsillectomy in youths. Laryngoscope. 2007;117(7):1272-9.
Paula, Carrasco-Llatas, M., Baptista-Jardin, P. M., Plaza-Mayor, G., Alfonso, & O’Connor-Reina, C. (2023). Surgical treatment of Obstructive sleep apnea: adenotonsillectomy in adults. Revista ORL, e30968. https://doi.org/10.14201/orl.30968
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